本文選題：肝炎 + 慢性��； 參考：《吉林大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2016年01期

【摘要】：目的:觀察干擾素α2b(INF-α2b)聯(lián)合利巴韋林治療慢性丙型肝炎(CHC)患者肝功能變化的特點(diǎn),探討不同病毒學(xué)應(yīng)答模式與肝功能的關(guān)系。方法:選取CHC患者264例,給予INF-α2b500萬U,隔日1次皮下注射;利巴韋林15 mg·kg-1,每日1次口服,療程48周。檢測(cè)不同時(shí)間點(diǎn)(基線,治療12、24、48和72周)患者HCV RNA定量和肝功能等指標(biāo)。根據(jù)轉(zhuǎn)歸情況,將患者分為持續(xù)病毒學(xué)應(yīng)答(SVR)組、治療中反彈組、復(fù)發(fā)組和無應(yīng)答組,比較4組患者治療前后肝功能的變化及與應(yīng)答的關(guān)系。結(jié)果:264例患者中171例(64.8%)獲得SVR,37例(14.0%)治療中反彈,47例(17.8%)復(fù)發(fā),9例(3.4%)無應(yīng)答。與治療中反彈組比較,基線丙氨酸氨基轉(zhuǎn)移酶(ALT)水平輕度升高的患者較ALT正常的患者易獲得SVR(P0.05)。經(jīng)抗病毒治療,4組患者血清ALT和天冬氨酸氨基轉(zhuǎn)移酶(AST)均下降,且12周時(shí)下降最明顯,與治療前比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。治療中反彈組患者在48周時(shí)ALT和AST回升,復(fù)發(fā)組患者停藥后24周時(shí)ALT和AST回升,直至停藥后24周SVR組患者的ALT和AST可維持穩(wěn)定。與治療中反彈組比較,SVR組患者在12周時(shí)ALT和AST下降更明顯,與治療前比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。在抗病毒治療過程中,無應(yīng)答組患者血清ALT和AST水平始終高于SVR組、復(fù)發(fā)組和治療中反彈組(P0.05)。與治療前比較,SVR組患者在12周時(shí)總膽紅素(TBIL)和直接膽紅素(DBIL)水平較其他時(shí)間點(diǎn)明顯下降(P0.05),直至停藥后24周可以維持穩(wěn)定。在治療24周時(shí),無應(yīng)答組患者血清TBIL、DBIL水平明顯高于SVR組和治療中反彈組患者(P0.05)。結(jié)論:CHC患者基線ALT水平可能與病毒學(xué)應(yīng)答有關(guān)。CHC患者抗病毒治療后肝功能改善,尤其SVR患者改善更明顯,隨著病毒的復(fù)發(fā)或反彈,轉(zhuǎn)氨酶會(huì)再次升高。
[Abstract]:Objective: to observe the changes of liver function in patients with chronic hepatitis C (CHCC) treated with interferon 偽 2b INF- 偽 2b) combined with ribavirin, and to explore the relationship between different virological response models and liver function. Methods: 264 patients with CHC were given subcutaneous injection of INF- 偽 2b500 once every other day, ribavirin 15 mg kg -1 daily for 48 weeks. HCV RNA quantification and liver function were measured at different time points (baseline, 12 weeks, 24 weeks and 72 weeks). According to the outcome, the patients were divided into three groups: persistent virological response (SVR) group, rebound group, relapse group and non-response group. The changes of liver function and their relationship with response before and after treatment were compared. Results 171 cases (64.8%) got SVRN (37 cases 14.0) in treatment, 47 cases rebounded (17.8%) and 9 cases (3.4%) did not respond. Compared with the rebound group, patients with slightly elevated baseline alanine aminotransferase (alt) levels were more likely to obtain SVRP-0.05 than those with normal ALT. The levels of serum ALT and aspartate aminotransferase (AST) in the 4 groups treated with antiviral therapy were all decreased, and the decrease was most obvious at 12 weeks after treatment, the difference was statistically significant compared with that before treatment (P 0.05). In the rebound group, ALT and AST increased at 48 weeks, and ALT and AST increased at 24 weeks after withdrawal in the relapse group, until ALT and AST remained stable in the SVR group 24 weeks after the withdrawal. Compared with the rebound group, the ALT and AST decreased significantly at 12 weeks, and the difference was statistically significant compared with that before treatment (P 0.05). In the course of antiviral therapy, the levels of serum ALT and AST in the non-response group were always higher than those in the SVR group, and the levels of serum ALT and AST in the recurrent group and the rebound group during the treatment were higher than those in the SVR group. The levels of total bilirubin TBILand direct bilirubin in SVR group were significantly lower than those at other time points before treatment, and remained stable 24 weeks after withdrawal. After 24 weeks of treatment, the serum levels of TBIL-DBIL in the non-response group were significantly higher than those in the SVR group and the rebound group (P 0.05). Conclusion the level of baseline ALT may be related to the virological response. The liver function is improved after antiviral therapy, especially in SVR patients. With the recurrence or rebound of the virus, the transaminase level will increase again.
【作者單位】： 吉林大學(xué)第一醫(yī)院肝膽胰內(nèi)科;
【基金】：國(guó)家自然科學(xué)基金資助課題(81072347);國(guó)家自然科學(xué)基金青年基金資助課題(81200289)
【分類號(hào)】：R512.63

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